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As part of the National Institute for Health Research, we use the skills, knowledge and expertise of researchers, health and social care professionals, managers, commissioners and patients to conduct high quality research projects to find new ways of improving healthcare. Our aim is to ensure the results of the research are translated quickly and effectively into benefits for patients, the wider NHS and social care.

Please see our About Us section for a recently developed info-graphic outlining the CLAHRC NWL journey so far.

Hand and Wrist Virtual Fracture Clinic Pathway

Most common
fracture presentation to A&E departments, UK

Hand and
wrist fractures are the most common
fracture presentation to accident and emergency departments within the UK.
Complications following both simple and complex hand and wrist fractures can
have devastating consequences. The British Orthopaedic Association recommends
initial assessment in a fracture clinic should take place within 72 hours and
any surgery should be performed within one week. It was the experience of
Raymond Anakwe (Consultant Trauma & Orthopaedic Surgeon) of Imperial
College Healthcare NHS Trust (ICHNT) that adult patients presenting with hand
and wrist fractures, experienced delays in: attending fracture clinics;
operative treatment; and in referral to rehabilitation. This resulted in
extended recovery times, sub-optimal outcomes, an increased number of hospital
visits, and overall poorer patient and staff experience.

An initial retrospective clinical
audit, showed that 31% (13/42) patients
waited over 15 days and another 28% (12/42) patients waited between 8-14 days
for surgery following fracture. Further analysis of these delayed patients
showed that the most frequent reasons for delay is delay in initial clinical review at fracture clinic.

Introduction
of a new pathway

The Hand and Wrist Virtual Fracture
Clinic planned to ensure prompt access for patients with fractures to receive expert review within 72 hours,
to achieve better patient outcomes, improve quality of care and improve
efficiency of the system. In the pre-intervention clinical review model, 100% of patients were referred from
A&E to the Hand Clinic for a face-to-face consultation with an
orthopaedic consultant (average 10 days from referral to expert review, audit
2016).

A new pathway (See Table 1),
incorporating implementation of e-referral and virtual review software was
implemented to reduce the time between presentation and expert review. This led
to accelerated triage of patients to one of three destinations: fracture
clinic, hand therapy and direct discharge after initial presentation via Urgent
care centres or ICHT A&Es.

Patient information leaflets developed and uploaded onto a public website

Education sessions delivered to healthcare professionals working in four of the five affiliated referral sources

Following the introduction of the Hand and Wrist Virtual Fracture
Clinic, 2,449 patients were referred to
the service: 60% of patients (1,451)
were referred to the Hand Clinic; 22%
of patients (549) were discharged with information on how to self-manage
their injury; and 18% (449) were
directly triaged to hand therapy. The time to expert review reduced from an
average of 10 days to an average of 1 day.

The tariff for face-to-face initial
hand (fracture) clinic consultation is costed at £151 per patient. For this project, 2449 patients were referred to
Virtual Fracture Clinic. In the traditional pathway, all these patients would
have been referred to the hand (fracture) clinic incurring a cost of £369,799. With the introduction
of the Virtual Fracture Clinic Pathway, only
1451 patients were referred for a hand (fracture) clinic consultation costing
£219,101 and resulting in a potential cost saving of £150,698 (setup and running costs not included).

How interventions are spread: CLAHRC NWL PhD Student Sophie Spitters Wins second prize at the Research as Art Summer Showcase

The Imperial College London Graduate School organised their annual Summer Showcase on Friday 13th July 2018. The showcase aims to celebrate research undertaken by PhD students at Imperial and invites staff, students and visitors to find out more about their work via a poster and a research as art exhibition. Sophie Spitters, joined the research as an art exhibition, showcasing her NIHR CLAHRC NWL research, and won second prize.

Her art installation, titled ‘How interventions are spread’, aimed to communicate the reality of spreading healthcare improvement interventions, which often does not follow the expected trajectory. Read more about Sophie's experience in our blog.